PERMFILE117978

• Permit No: M2001023
• IBM Index Class Name: Permit File
• Doc Date: 6/14/2001
• Doc Name: PARTY STATUS REQUEST FORM
• Media Type: D
• Archive: No

~TATE OF COLORADO
MINED LAND RECLAMATION BOARD ~~~~2--
PARTY STATUS REQUEST FORM
In the matter of File No. M~i - ~a> Permi~(ertndit endinent Application
Dame ~~f Operat'oJr/Ap lican and SitlIe: ~ti'1 I SYLS ~Lfi1C.
c~ mll~. ~(l~ t~ mI~MY, ~A" n.`d~ ~1D)nC.C 8 Chi-l~il I l/V P ~ ~. ~I~P//
,~ I request that I be named as a party RECEIVED
I request that I not be named as a party JUN 1 4 2001
I request to be withdrawn from party status Division of Minerals and Geology
I understand that if I am not a party, my statements of concern or objection to this
application will not be considered during the review of the application, but I may address
the Board on this matter at the Cmal hearing, and may present my concerns as an
interested member of the public.
For people who do not wish to become parties in this matter, information on permit
application status can be requested from the Division of Minerals and Geology.
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tinted N e~7 C G (y _ _ L Home Phone #
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Ctty, Stat Zip Code FAX # ~ 1 ~ ~ 1] ~- 5'~ l/~
E-Mail Address .~~~.a ~ l0 ~ ~~
Signature Da e
If you are requesting to be named as a party, please briefly describe below:
1. how you may be affected or aggrieved by the Boazd's decision in the matter referenced above,
2. your opposition to the matter, including a specific description of the issues that you feel need
to be addressed at the final hearing. (You may attach a written statement to this form instead
of using the space below.)
~e~ ~~ern~
County of ~ou"tl"
State of~o oCa
Subscribed and sworn before me this 13th day of
June, 2001 by .Deborah K. Landers
Notary Public for the State of._Colorado
Residing at 37925 RCR 179, Steamboat Springs, CO My Commission Expires
My Commission expires 9~~ 09/0612004